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Fracture

Clinical Discipline(s)/Organ System(s)
Emergency Medicine, Musculoskeletal System, Orthopaedics, Paediatrics, Radiology
Progress Test Topic(s)
Musculoskeletal
Description
A mother presents to the Emergency Department with her 2 year old NZ European child who is not using their right arm.
Progress Test-Type Questions:   Question 1
Applied Science for Medicine 
   - Structure and function of the growing skeleton
   - Normal growth and developmental milestones of infant
   - Microbiology and pathogenesis of bone and joint infections
   - Pharmacology of pain relief, specific to children, including non-medication techniques
   - Pathophysiology and genetics of disorders of bone development and structure
Clinical and Communication Skills 
   - Examination of the young unco-operative child, including evaluation of sepsis and/or acutely unwell child
   - Detailed history and documentation from family/caregivers of an event; obtaining validation from other carers
   - Differential diagnosis of a child not using a limb
   - Interpretation of plain X-rays in infants and children
   - Features (important red flags) for non-accidental injury in history, examination and presentation time
   - Management of pain in a young child
   - Management of musculoskeletal injury in outpatient setting and indications for orthopaedic referral
Personal and Professional Skills 
   - Non-judgemental attitude to history of events
   - Discussion of non-accidental injury with the parents
   - What to do when you suspect non-accidental injury including professional and legal obligations
   - Establish a relationship with patient and family/whānau
Hauora Māori 
   - Self-reflective competencies: awareness of possible personal stereotypes/assumptions around Māori and about child abuse
   - Awareness of disproportionate impact of socioeconomic deprivation on Māori and appropriate response
   - Recognition of disproportionate impact of preventable injury in childhood on Māori and Pacific people
Population Health 
   - Paediatric orthopaedic and acute surgical services in NZ
   - Preventable accidents and safety in the home and community
   - Prevalence, risks and resources for non-accidental injury and resources; strategies for prevention
   - Roles of Child, Youth and Family/Puawaitahi services
Conditions to be considered relating to this scenario
Common
fracture, osteomyelitis, septic arthritis, deep skin or soft infection, pulled (dislocated) elbow
Less common but 'important not to miss'
non-accidental injury, malignancy
Uncommon
neurologic event, osteogenesis imperfecta